The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more!

By Jonathan Gelber

MMA is one of the world’s fastest growing sports. The Ultimate Guide to Preventing and Treating MMA Injuries offers professional and amateur fighters and fans alike the sound professional advice they need to prevent and treat injuries, find a good training camp and partners, train smarter — not harder — and choose the right equipment. Dr. Jonathan Gelber translates complicated medical topics into a guide full of practical, easy-to-follow information, complete with step-by-step photos and diagrams. From joint injuries to preventing infection, from muscle strains to the hot topic of head injuries and concussions, Dr. Gelber outlines all the need-to-know details.

Featuring advice from more than 40 UFC Hall of Famers and champions, as well as many of MMA’s top athletes and elite trainers, The Ultimate Guide to Preventing and Treating MMA Injuries is a must-have for anyone serious about today’s fight game.

• Language: English
• Publisher: ECW Press
• Release date: May 1, 2016
• ISBN: 9781770908345

Jonathan Gelber

Jonathan Gelber, MD, MS, is an orthopedic surgeon. He attended the University of Miami, where he received both a BS in biology and a BA in chemistry with honors. Dr. Gelber completed a master's degree in biomedical engineering at Columbia University and graduated with distinction in research from the Mount Sinai School of Medicine in New York City. He then went on to complete an Orthopedic Surgery residency at Harbor-UCLA and additional subspecialty fellowship training in sports medicine at the world-renowned Cleveland Clinic. Dr. Gelber is an author on numerous scientific journal papers and chapters as well as the author of The Ultimate Guide to Preventing and Treating MMA Injuries. 

Book preview

FEATURING ADVICE FROM

UFC HALL OF FAMERS

RANDY COUTURE,

KEN SHAMROCK,

BAS RUTTEN,

PAT MILETICH,

DAN SEVERN

AND MORE!

JONATHAN GELBER, M.D., M.S.

TO MY WIFE, CHILDREN, AND PARENTS

FOR THEIR LOVE AND SUPPORT.

AND TO THE ATHLETES AND COACHES

WHO SACRIFICE FOR THE SPORT.

CONTRIBUTORS/INTERVIEWEES

(15 UFC TITLEHOLDERS 6 UFC HALL OF FAMERS, 32 MMA FIGHTERS, 7 ELITE TRAINERS, AND MORE)

Ken Shamrock (UFC HoF)

Frank Shamrock

Bas Rutten (UFC HoF)

Randy Couture (UFC HoF)

Sean Sherk

Dan Severn (UFC HoF)

Pat Miletich (UFC HoF)

Mark Coleman (UFC HoF)

Demetrious Johnson

Josh Barnett

Matt Serra

Carlos Condit

Carlos Newton

Tim Sylvia

Mark Hunt

Don Frye

Renzo Gracie

Gilbert Melendez

Matt Brown

Mario Sperry

Brandon Vera

Tim Kennedy

Dean Lister

Duane Ludwig

Jeff Monson

Pete Spratt

Stipe Miocic

Ed Herman

Nate Quarry

Guy Mezger

Patrick Côté

Matt Lindland

Stitch — MMA and boxing’s legendary cutman

Ricardo Liborio — Elite trainer/coach, co-founder American Top Team (ATT)

Cesar Gracie — Elite trainer/coach, Cesar Gracie team

Mark DellaGrotte — Elite trainer/coach, Team Sityodtong

Mike Winkeljohn — Elite trainer/coach, Jackson-Winkeljohn team

Javier Mendez — Elite trainer/coach, American Kickboxing Academy, (AKA)

Greg Nelson — Elite trainer/coach, the Academy

Ray Longo — Elite trainer/coach, Serra/Longo competition team

Big John McCarthy — Referee and advocate

Bruce Buffer — The Voice of the Octagon

Andy Foster — Former fighter and California Athletic Commissioner

CONTENTS

FOREWORD BY A RINGSIDE DOC PIONEER

DR. JOE ESTWANIK

INTRODUCTION AND BACKGROUND

1. HEAD TRAUMA AND PROLONGING YOUR CAREER

• NECK STRENGTHENING EXERCISES WITH STIPE MIOCIC

2. LACERATIONS AND THE CUTMAN’S BEST FRIEND

3. EYE INJURIES AND ORBITAL FRACTURES

• THE FIGHTER’S CORNER: MENTAL PREPARATION BY FRANK SHAMROCK

4. KNEE INJURIES AND RETURNING TO THE OCTAGON AFTER SURGERY

• KNEE INJURY PREVENTION EXERCISES

5. SHOULDER INJURIES AND HOW AN INJECTION CHANGED THE ODDS IN VEGAS

• SHOULDER INJURY PREVENTION EXERCISES

6. HIP INJURIES AND THE HAMMER’S HIP

• HIP STRENGTH AND FLEXIBILITY EXERCISES

• THE FIGHTER’S CORNER: A CAUTIONARY TALE BY KARO PARISYAN

7. HAND INJURIES AND MAKING APPLESAUCE BARE-HANDED

• THE FIGHTER’S CORNER: HAND WRAPPING WITH MARK DELLAGROTTE

8. SKIN INFECTIONS AND HOW MARK DELLAGROTTE SAVED TUF

9. WEIGHT-CUTTING, PEDs, AND TRT

10. INJURY PREVENTION: THE KEY LESSONS

• THE FIGHTER’S CORNER: STRUCTURING A TRAINING CAMP WITH GREG NELSON, DEMETRIOUS JOHNSON, AND PAT MILETICH

LIST OF KEY TERMS AND ATHLETES

ABOUT THE AUTHOR

COPYRIGHT

FOREWORD BY A RINGSIDE DOC PIONEER

DR. JOE ESTWANIK, FORMER PRESIDENT AND CO-FOUNDER, ASSOCIATION OF RINGSIDE PHYSICIANS

As a young sports medicine doctor in the early 1980s, I was requested to assist as a ringside physician in a USA Boxing National Championship in my hometown. With my martial arts and wrestling background, I easily bonded with the athletes, coaches, officials, and refs. However, despite my enjoyment of the event, I felt something was off. The sports science available for this elite tournament was out of sync with what was then the current standard of sports medicine. I realized I needed to rapidly apply what we already knew in sports medicine to the boxing world. As I began to work on bringing science and medicine to the sport and to these athletes, I looked to my mentor Necip Apri, M.D. — a wizard at the fight game. It was amazing how often he could accurately predict outcomes and injuries! Soon, true ringside medicine was born, and I was at the forefront.

My interest allowed me to serve as chairman of sports medicine for USA Boxing and travel the world with our team for many years, including to Russia at the height of the Cold War. Then, suddenly out of Brazil came an everything goes combat — the early years of mixed martial arts. I quickly latched on to this great sport and was a ringside physician at UFC 3 in 1994. Soon after, I worked as a team with the Gracie family, Big John McCarthy, and others to form MMA as we know it today. I helped establish rounds, referees, weight classes, and the number of fights per day for a competitor. I designed the original grappling glove with the help of my friends, particularly Big John McCarthy and John Perretti.

In the world of medicine, there is a standard of care that is applied to all athletes. These gold standards for injury prevention, recognition, and recovery are almost universally applied, irrespective of the sport. The knowledge currently available must be extended to and applied to athletes within traditional team sports, such as baseball, basketball, and football, as well as non-traditional and combat sports. A torn ACL in the knee of a football player is not different than a torn ACL in a wrestler’s knee. A concussive impact from heading a soccer ball affects the same type of neurons disrupted from a punch that connects with a boxer’s head. The many systemic disruptions created by starvation, dehydration, and incomplete rehydration affect all athletes, including wrestlers, boxers, MMA fighters, or even military warriors.

However, one must also keep in mind that each sport generates injuries and mechanisms of injury specific to the training and competition of the respective athletes. For example, the chapter on shoulder injuries excellently details exposure to pressures on the shoulder joint commonly produced by martial arts/boxing demands that may not be found in other sports. MMA athletes deserve a sports medicine team familiar with the specific demands, rules, mechanisms of injury, and rehabilitation techniques unique to the combat arts. The team should include coaches, certified athletic trainers, strength/conditioning coaches, nutritionists, and physicians familiar with the sport of MMA. My advice is to search out a doctor familiar with the demands of your sport. At the time of writing this, the Association of Ringside Physicians in conjunction with the American College of Sports Medicine have created a certification in ringside medicine that may be one guide to help you find a doctor familiar with boxing/MMA. And always be wary of the doctor who would rather be your friend at an event than a doctor treating you as a patient.

As athletes, your responsibilities and duties span three time zones: pre-event, intra-event, and post-competition.

PRE-EVENT

Choose your correct certified weight class by measuring your body fat percentage using skin calipers or other measures of hydration. Wrestling coaches and athletic trainers have measured many tens of thousands of competitors and are familiar with the tools available. Be judicious in the amount and aggressiveness of sparring. Training harder does not mean sparring harder. It is known that many of Muhammad Ali’s detrimental impacts occurred during his vicious sparring sessions. Just as football coaches are recently limiting full-contact sessions, fighters should follow the same advice. Be honest to your coaches in declaring injuries, headaches, and concussions.

INTRA-EVENT

Just as the referee serves as a neutral judge of the rules, the ringside physician referees your immediate and long-term health and safety. Listen to the referee or fight doctor if he stops a fight and accept his decision. It’s better to live to fight another day!

POST-COMPETITION

Cooperate with the ringside doctor’s instructions for follow-up care. Even sub-concussive (non-knockouts) require physical and mental rest. You should avoid celebrating with alcohol consumption for several days after a bout, as recent studies note impaired brain-cell healing with alcohol. Seek experts in injury rehabilitation, such as physical therapists who understand the specific demands of your sport.

This book by Jonathan D. Gelber, M.D., M.S., shares his interest and expertise in sports medicine to educate those involved in mixed martial arts. The dedicated athletes of this ancient art do not deserve ancient science. The sound advice provided by Dr. Gelber illustrates the gold standards that you so deserve.

JOSEPH J. ESTWANIK, M.D., FACSM

Author of Sports Medicine for the Combat Arts

President of the Association of Ringside Physicians 2011–2014

INTRODUCTION AND BACKGROUND

I have been a fan of mixed martial arts since before the term MMA even existed. I was first exposed to the ground game of grappling via classes in shootfighting and Gracie Jiu-Jitsu. I recall passing around videotapes of Pride and the early UFCs among our jiu-jitsu class, because not everyone could get the shows on their TV. You could only watch the UFC on satellite TV or buy Pride videos at f.y.e. in the mall. I also searched eagerly for the legendary Gracie in Action videotapes showing the birth of Gracie Jiu-Jitsu in Brazil. Fast-forward 15 years, and MMA is one of the world’s fastest growing sports with shows or bouts on TV almost any night of the week and major cards happening almost weekly.

As the sport evolved from the early wars of strictly Brazilian Jiu-Jitsu versus American wrestling (think Royce Gracie versus Dan Severn or Ken Shamrock) to the gradual inclusion of Muay Thai strikers, the training of fighters has also evolved. From the pioneers of mixed martial arts, whose main goal was to be the toughest or strongest guy in the gym, elite, versatile athletes have emerged, training year round in strength, conditioning, cardio, and technique in one of the most physically demanding sports on the planet. Unfortunately, while the fighters have evolved, the support system around them has not. When it comes to many areas of injury prevention and treatment, MMA is still stuck in the Dark Ages.

As a doctor, fan, and participant, I began to notice that there is not a lot of good advice out there for the MMA athlete. As a result, athletes merely ignore their injuries or take the advice of a well-meaning but self-proclaimed expert whom they train with at their gym — not always the best source of information. In my experience, many mixed martial artists do not have insurance or do not think traditional medical doctors have much to offer them — but nothing could be further from the truth. MMA fighters are very in touch with their bodies, and many prefer a holistic approach to their health, but ignoring science and medicine puts them at risk for a shorter career.

The medical community has learned a lot about injury prevention from mainstream sports such as baseball, football, basketball, and soccer. And because of that, these million-dollar athletes rely on their team’s athletic trainers, physical therapists, and team doctors for advice. But the MMA community hasn’t yet adequately applied this knowledge to our sport, and with even more cards and more fighters eager to get on pay-per-view or fight for a world title, the number of injuries in MMA is rising. Without the proper education on injury prevention and treatment, many fighters develop tunnel vision and focus only on the fight in front of them. They do not pay attention to their bodies and the long-term consequences of their actions and training routines. And when their careers abruptly end or their bodies begin to break down, they struggle to remain relevant in the MMA world. However, with the help of a trained support system, these fine athletes will be able to prolong their careers and limit the chronic injuries they will have to deal with when they retire.

In order to help educate fighters, fans, and trainers, I began my website FightMedicine.net. Through my interaction with readers, many of whom come from all levels of MMA organizations, I realized there weren’t enough adequate resources for members of the MMA community to turn to for advice. Thus, I decided to use my medical training and passion for the sport to write a book on MMA injuries, treatment, and prevention. To do that, I interviewed many UFC titleholders and Hall of Famers, MMA legends, current fighters, and their trainers. The advice they provided coupled with sound medical information will benefit both the current and next generation of mixed martial artists. MMA athletes deserve the same level of sports medicine as athletes in more traditional sports. I, along with many other medical professionals and scientists, want to see this sport grow safely and the careers of these athletes last as long as possible.

Rather than create a laundry list of all the possible injuries that could occur in MMA, I have instead focused on some of the more common injuries based on what I have seen as a doctor, what appears in the news, and what has stood out among fighters. In addition, I have included some injuries I find interesting, some that can seriously affect a fighter’s ability to return to the cage, and others that can be prevented with proper training.

In my many hours of interviews with current MMA fighters, retired legends, and some of the top trainers in the sport, a few themes repeatedly came up in the conversation. Sometimes, it was as if I had pressed play on a recorded interview from someone else. While the advice may seem obvious or simple on the surface, the actual application of these guidelines to MMA training is often overlooked or not deeply understood by the fighter and his team. Based on my research, the top five principles of injury prevention are:

Choose the right camp and surround yourself with good people.

Use proper equipment in all aspects of training.

Listen to your body (not your ego) and adapt.

Avoid overtraining.

Train smarter, not harder.

Jonathan D. Gelber, M.D., M.S.

founder of FightMedicine.net and the MMA Research Society

CHAPTER 1

HEAD TRAUMA AND PROLONGING YOUR CAREER

CONCUSSIONS

The face of a fighter often tells their biography. Broken noses and cauliflower ears are usually tell-tale signs of a career in combat sports. These common injuries, however, are often only superficial. Much of the damage of a career in a combat sport such as MMA is under the surface. Concussion and brain injury are serious issues and more attention needs to be paid to the symptoms fighters experience. Instead of seeking treatment after a concussion, fighters chalk it up to simple run-of-the-mill injury and try to go on with their usual routine, even when something feels off.

MMA legend and pioneer Frank Shamrock admits to misunderstanding the severity of brain injuries as he describes his fight against Yuki Kondo in 1996 at Pancrase in Japan: After 12 exhausting minutes of non-stop fighting, Yuki kicked me in the face and knocked me backwards. I fell through the second rope and hit my head on the metal floor. It knocked me out for about two seconds and they called the fight. That’s the only time I ever got knocked out. I got up and felt woozy. I was sick to my stomach. I recovered pretty quickly and went out that night and had a good time. The next morning, I woke up and starting walking out of my hotel room. When I went to grab the doorknob, I found it was two inches to the left of where I grabbed. All that day in Japan, it kept happening. I flew home the next day and it still kept happening.

Another unfortunate example of not recognizing the symptoms of a concussion occurred at UFC 17. At that event, Lion’s Den fighter Pete Williams fought former UFC Heavyweight Champion Mark Coleman in the